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1、Neck I injury The Use of X-Rays, CTs, and MRIs to Study Crash-Related Injury Mechanisms Jeffrey A. PikeNeck Injury The Use of X-Rays, CTs, and MRIs to Study Crash-Related Injury Mechanisms Jeffrey A. Pike Society of Automotive Engineers, Inc. Warrendale, Pa. Copyright 2002 Society of Automotive Engi

2、neers, Inc. eISBN: 978-0-7680-6595-4Library of Congress Cataloging-in-Publication Data Pike, Jeffrey A. Neck injury : the use of x-rays, CTs, and MRIs to study crash-related injury mechanisms / Jeffrey A. Pike. p. cm. Includes bibliographical references and index. ISBN 0-7680-0905-7 1. NeckWounds an

3、d injuries. 2. Crash injuries. 3. Whiplash injuries. 4. NeckImaging. I. Title. RD533.5 P55 2002 617.53044dc21 2002021704 Copyright 2002 Society of Automotive Engineers, Inc. 400 Commonwealth Drive Warrendale, PA 15096-0001 U.S.A. Phone: (724) 776-4841 Fax: (724) 776-5760 E-mail: publicationssae.org

4、http:/www.sae.org ISBN 0-7680-0905-7 All rights reserved. Printed in the United States of America. Permission to photocopy for internal or personal use, or the internal or personal use of specific clients, is granted by SAE for libraries and other users registered with the Copyright Clearance Center

5、 (CCC), provided that the base fee of $.50 per page is paid directly to CCC, 222 Rosewood Dr., Danvers, MA 01923. Special requests should be addressed to the SAE Publications Group. 0-7680-0905-7/02-$.50. SAE Order No. R-268To DebraContributors Ronald S. Adler Professor, Department of Radiology, Wei

6、l School of Medicine, Cornell University and Attending Radiologist, Hospital for Special Surgery Jeffrey S. Augenstein Professor of Surgery, Division of Trauma and Surgical Critical Care and Director, William Lehman Injury Research Center, University of Miami School of Medicine Mary Ann Gregor Senio

7、r Research Associate, University of Michigan Medical School and Administrative Director, University of Michigan Injury Research Center Tristram Horton Clinical Research Associate, William Lehman Injury Research Center University of Miami School of Medicine Donald F. Huelke Professor Emeritus, Depart

8、ment of Anatomy, University of Michigan Medical School and Senior Research Scientist Emeritus, University of Michigan Transportation Research Institute Ronald F. Maio Associate Professor, Department of Emergency Medicine, University of Michigan Medical School and Director, University of Michigan Inj

9、ury Research Center vNeck Injury Jeffrey A. Pike Senior Technical Specialist, Environmental from presentations that I have made at various technical conferences and at various government and industry forums; and from lec- tures that I have given through the SAE Seminar Program. The attendees at thes

10、e events provided much useful feedback and helped me to identify the information that would be most useful to include in this volume. One of the most rewarding aspects of writing this book has been interacting with the very talented people mentioned below. Although very busy, they were all quite gen

11、erous with their time and expertise. They taught me a great deal, not only about the subject matter, but also about graciously helping others. The co-authors: Ronald S. Adler PhD MD, Jeffrey S. Augenstein MD PhD, Mary Ann Gregor MHSA, Tristram Horton BS MD IIb, Donald F. Huelke PhD, Ronald F. Maio D

12、O, Frank A. Pintar PhD, and Narayan Yoganandan PhD. The reviewers: O. Petter Eldevik MD, Mark Falahee MD, Barry Gross MD, Julius Huebner MD, Guy Nusholtz PhD, and James Szocik MD. The following people provided various figures, radiological images, and/or case studies. The figures, of course, helped

13、to clarify the various concepts. A great deal of effort was expended in obtaining films that were easy to read and that readily illustrated the points being made. And finally, the case studies helped to tie together the injury, radiological, and vehicle aspects of crash injury: ix Neck Injury Ronald

14、 S. Adler PhD MD, Jeffrey S. Augenstein MD PhD, John Cavanaugh MD, Mary Ann Gregor MHSA, Tristram Horton BS MD IIb, Donald F. Huelke PhD, Ronald F. Maio DO, Frank A. Pintar PhD, Harry Smith PhD MD, and Narayan Yoganandan PhD. Last but not least, my thanks to Martha Swiss and the Publications crew at

15、 SAE. SAEs helpfulness and professionalism in the past helped me to decide to write this second book (first book was Pike 1990), and this current collabo- ration has made me think in terms of book “number three.“ x Introduction This book is unique in that it is intended for the wide variety of profe

16、ssionals involved in the study of crash-related neck injury. For those with primarily a vehicle background, it provides an overview of how x-rays, CTs, and MRIs may be used as a source of information to help analyze vehicle crashes and the associated injuries. For those with primarily a clinical bac

17、kground, it provides insight into how injuries relate to the vehicle crash. Determining the type of motion(s) associated with a particular injury can be of considerable importance for several reasons. These include: (1) helping to understand how to reduce the risk of such injuries in the future; (2)

18、 providing insight into how a particular injury should be treated; and (3) alerting the health-care provider to specific concomitant injuries that may be associated with a particular injury, but which are quite subtle and easy to overlook (especially initially). This book draws upon various experien

19、ces that I have had during my 25+ years in automotive safety, especially lectures that I delivered at univer- sities, technical societies, and government and industry forums. More specifi- cally, the university lectures included those at Harvard Medical School, the University of Michigan, and Wayne

20、State University. Government and indus- try forums included organizing and/or presenting at meetings of the Detroit Institute of Ophthalmology, Florida State Legislature, National Highway Traf- fic Safety Administration (NHTSA), White House Conferences, the SAE Government-Industry Meeting, and Arizo

21、na and Michigan Councils of Gov- ernment. I have also had the opportunity to review research proposals for the U.S. Centers for Disease Control and review technical papers for the Asso- ciation for the Advancement of Automotive Medicine, Society of Automotive Engineers (SAE), and National Academy of

22、 Sciences/Transportation Research Board. Last but not least, during the last 15 years, I have organized and presented at more than 50 SAE conferences and technical seminars. This book is intended to provide an introduction to plain film radiographs (“x-rays“), computed tomograms, and magnetic resona

23、nce images such that vehicle safety professionals can use these techniques to help piece together the puzzle and provide a better understanding of the relationship between vehicle crash scenarios and occupant injury. It is intended to foster communication and collaboration in the increasingly comple

24、x and interdisciplinary fields of biome- chanics, injury mechanism, injury mitigation, and injury treatment. The book is xi Neck Injury also intended to be of use to those safety professionals who interact with biome- chanics or with EMS personnel, neurosurgeons, orthopaedists, radiologists, or othe

25、r care providers. Although much of the text and almost all of the illustra- tions refer to the neck, many of the discussions regarding x-rays, CTs, and MRIs should be applicable to other body regions as well. The text of this book is divided into three chapters: 1, Anatomy; 2, Imaging; and 3, Injuri

26、es and Injury Mechanisms. Chapter 1, Anatomy, provides an intro- duction to some anatomical, physiological, and biomechanical terminology and concepts relating to the bodys structure, function, and physical limits. These terms and concepts are used in the other chapters. Chapter 2, Imaging, dis- cus

27、ses imaging modalities encountered in the trauma environment, most notably plain film radiographs (x-rays), computed tomography (CT), and magnetic reso- nance imaging (MRI). The discussion describes the various views, how they are generated, and the type of injury and injury mechanism information ea

28、ch view may provide. Chapter 3, Injuries and Injury Mechanisms, provides a dis- cussion about the types of injuries that can occur in a vehicle crash and the mechanisms thought to underlie them. Most of the technical terms are defined as they are introduced into the discussion; therefore, the book s

29、hould be “read- able“ without a clinical or injury biomechanical background. However, the book also discusses some fairly advanced concepts and should be of interest to those with clinical and/or biomechanical backgrounds as well. The topic coverage is not uniform throughout the text, but rather pro

30、vides different levels of detail as appropriate to enable the reader to derive the maximum possible information from the available images and to help put the various images and case studies into context. This book has been written without seeking to provide an exhaustive (or exhausting) treatment of

31、 these very broad subjects, but rather to teach useful, important concepts and to point toward other sources. Like the cervical spine, the circumference of which varies along its length (presumably the thickness varies to accommo- date the functional requirements at each level), the text varies, bei

32、ng more detailed for some topics than for others. It is hoped that the distribution selected will serve well, not only to address current interests, but to provide a useful framework in which to understand and apply future developments. xiiChapter 1 Anatomy JEFFREY A. PIKE DONALD F. HUELKE INTRODUCT

33、ION This chapter briefly discusses some terminology and concepts relating to the structure and function of the human body and relating to injury. Many of these terms and concepts will be used in the remainder of the book.1 ANATOMY The normal spine for an individual standing straight is not straight,

34、 but rather has three major curves (in the mid-sagittal plane), approximately corresponding to the cervical, thoracic, and lumbar regions (Figures 1.1 and 1.2). The most superior curve, referred to as the cervical curve, is convex ventrally and extends from the top of C2 (the apex of the odontoid pr

35、ocess, or dens) (Figure 1.3) to the middle of T2. The cervical curve is not present at birth, but rather develops during the first year (Clemente 1985). When the spinal curva- ture is exaggerated, it may be indicative of some pathology. Three types of spinal curvature are kyphosis, lordosis, and sco

36、liosis. Kyphosis is a spinal curvature that is concave anteriorly (e.g., a hump-type shape); lordosis refers to a curvature that is concave posteriorly (e.g., swayback); and scoliosis is a serpentine shape in the coronal plane (e.g., characterized by uneven shoulders and a prominent shoulder blade).

37、 1 It is anticipated that people with a wide variety of backgrounds will be using this book and that some of the material will be more familiar to some readers than to others. Those wishing a brief review of terminology such as “distal,“ “proximal,“ “mid-sagittal,“ and “C2“ are referred to a text su

38、ch as Pike 1990. 1 Neck Injury Figure 1.1 The regions of the spine. Reproduced with permission. Source: Pike 1990. The typical cervical vertebra consists of an opening in the central section of the bone, and this opening is referred to as the vertebral foramen. It is through this opening that the sp

39、inal cord passes (Figure 1.4). The cord starts at the top of the column and continues down to the lumbar region. Also, there are various ligaments (flexible, sinewy tissues that bind the vertebrae together). These ligaments connect two or more adjacent vertebrae or, in some cases, run along the leng

40、th of the column. The intervertebral discs (Figures 1.2 and 1.5) are located between each vertebra in the cervical, thoracic, and lumbar regions (except for C1 and C2). Branches of the spinal cord, called nerve roots, connect the spinal cord to the face, limbs, and torso (Figure 1.6). 2 Anatomy Figu

41、re 1.2 Vertebral column, lateral view. Reproduced with permission. Source: Moore, K.E. Clinically Oriented Anatomy, 2nd Edition. Williams & Wilkins (Baltimore), 1985. One of the most important character- istics of the normal spine is that adjacent vertebrae are able to move with respect to each othe

42、r. When a person is standing erect, the vertebrae typically are stacked on top of each other, the front portion of each vertebra (C2 through L5) separated from the front portion of the upper and lower neigh- boring vertebrae (the suprajacent and subjacent vertebra, respectively) by an intervertebral

43、 disc. It is the combination of the cushion-like discs separating the vertebrae, and the sinewy ligaments tying the vertebrae together, that helps to give the vertebral column its flexibility. (The discs also help to hold the vertebrae togethereach disc is firmly attached to the subjacent and suprajacent vertebrae, between which Figure 1.3 Vertebra C2 (the axis). Reproduced with permission. Source: Huelke 1979. 3